Current through Reg. 50, No. 187; September 24, 2024
(1)
Upon receipt of the Basic Medication Administration training certification and
validation certification, MAPs are authorized to administer medications or to
supervise the self-administration of medications via the following medication
routes for which the MAP has been validated:
(a) Oral;
(b) Enteral, with the exception of prescribed
enteral formulas;
(c)
Transdermal;
(d) Otic;
(e) Ophthalmic;
(f) Rectal;
(g) Inhaled; and
(h) Topical.
(2) MAPs that have not completed the
Prescribed Enteral Formula Administration Training and received the
corresponding training certification and validation certification shall not
administer Prescribed Enteral Formula.
(3) Licensed health care practitioners shall
administer or supervise the self-administration of medications within their
scope of practice.
(4) MAPs and
licensed health care practitioners shall:
(a)
Only provide administration of medication or supervision with
self-administration of medications as prescribed or ordered by the client's
health care practitioner and which are properly labeled and dispensed in
accordance with chapters 465 and 499, F.S. If multiple clients are prescribed
identical OTC medications, the facilities may utilize a single stock container
to provide the medications to multiple clients;
(b) Comply with new or changed orders for a
specific medication, which override the previous orders for that medication. No
order to discontinue the previous order is necessary;
(c) Comply with the time limit as provided
for in time-limited orders (i.e. those that are ordered for a specific number
of doses or days). Such orders do not require an order to discontinue at the
completion of the time allotted in the time-limit;
(d) Before administering medication or
supervising the self-administration of medication, become familiar with the
client's medical history and medication background and locate the name and
contact numbers of the client's prescribing practitioner for consultation
regarding the prescribed medications;
(e) Perform appropriate hand sanitation
measures before administering medication or supervising the self-administration
of medication, with repeated sanitization as needed during medication
administration;
(f) Assist only one
client at a time with medication administration in a quiet location free from
distraction;
(g) Only prepare
medications for one client, at the time the medication is given;
(h) Following the administration of
medication or supervision of self-administration of medication, return each
client's medication to its portable or permanent medication storage location
before assisting another client;
(i) Call the client's primary care provider
within 24 hours to reconcile the client's medications with those ordered upon
the client's discharge from any inpatient, emergency, or urgent care facility.
This call must be documented, along with the primary care provider's response,
including any instructions for medication administration and follow up. The
primary care provider's failure to respond should also be documented, along
with continued attempts to contact him or her. If no licensed person is present
to take the instructions from the primary care provider, the MAP must also ask
for faxed or electronically supplied instructions;
(j) Immediately report torn, damaged,
illegible, or mislabeled prescription labels to the dispensing pharmacist and,
if a client is residing in a residential facility, notify the facility
supervisor;
(k) Check the
directions and expiration date of each medication to ensure that expired
medications (those which are no longer current) or those no longer prescribed
are not administered;
(l) Continue
to provide medications for which there is a current prescriber order and the
medication is not expired, but the prescription itself is expired, until the
current supply is exhausted, or, in the case of a PRN medication, for no longer
than 6 months after the date the prescription expired;
(m) Verify that the correct medication is
administered to the correct client, at the correct time, with the correct
dosage, by the correct route, and for the correct reason, as prescribed by the
health care practitioner;
(n)
Observe complete ingestion of oral medication before leaving the client and
before recording or documenting the administration of the medication on the
MAR;
(o) Record the date, time,
dosage, and name of each regularly scheduled medication or PRN medication on
the MAR immediately following administration or supervision of
self-administration and sign or initial the entries. For PRN medications, the
MAP or licensed health care practitioner must also enter the reason for the
medication on the back of the MAR (if using the APD MAR form adopted in rule
65G-7.008, F.A.C.) or in a place
provided for such an entry on a pharmacy-provided or electronic MAR;
(p) Following the first three doses of a new
medication, including PRN medications, observe the client directly for a
minimum of 20 minutes and document observations to detect and respond
immediately to potential side effects, unless ordered differently by the
prescribing health care practitioner, and review the MAR for any special
instructions by the prescribing practitioner regarding required observations.
This documentation shall include both adverse reactions or a lack of adverse
reactions to the new medication;
(q) Enter the response to the medication on
the back of the MAR for PRN medications (state whether the medication
alleviated the symptom for which it was given, e.g. "headache is better") or in
the place provided for such an entry on a pharmacy provided or electronic MAR.
This entry should indicate date and time of entry, and be initialed or signed
by the MAP or licensed health care practitioner;
(r) Ensure that the prescription for a
medication is promptly refilled so that a client does not miss a prescribed
dosage of medication. If the MAP or licensed health care practitioner is not
responsible for routine refills of a medication, he or she shall notify the
individual responsible for refilling the client's prescriptions that the client
needs a medication refill and document this notification;
(s) Keep on-site a copy of the prescription,
order, or pharmacy profile with the client's MAR or medical record, written or
printed legibly and displaying the following information:
1. The client's name;
2. The name of the medication;
3. The prescribed dosage;
4. The time intervals or specific times the
medication must be given;
5. The
administration route by which the medication must be given;
6. Specific directions for use;
7. The medical reason or diagnosis for which
the medication was ordered or prescribed; and
8. For PRN medications, the complaint for
which the medication is ordered, the maximum number of days that the medication
should be given, the maximum number of doses per day, and conditions under
which the health care practitioner should be
notified.
(5)
Licensed health care practitioners and MAPs who are validated to administer or
supervise self-administration of whole (not crushed) oral medication may give
the medication in any substance that facilitates swallowing and is tolerated by
the client.
(6) A MAP who has been
validated to administer or supervise self-administration of prescribed enteral
formulas may administer prescribed enteral formulas through gastrostomy tubes,
including percutaneous endoscopic gastrostomy ("PEG"), button-style
gastrostomy, and jejunal ("JT").
(7) In the administration of medications, a
MAP shall not:
(a) Assist with the
administration or supervise the self-administration of any OTC medication or
medication samples without a written order by the client's physician, PA, or
APRN;
(b) Crush, dilute, or mix
crushed medications without instructions from the prescribing health care
practitioner or licensed pharmacist that have been transcribed to the
MAR;
(c) Administer medications or
supervise the self-administration of medications, including PRN and OTC
medications, unless a health care practitioner has provided directions for the
medication;
(d) Prepare syringes
for a client's use during the self-administration of medication via a
subcutaneous, intra-dermal, intra-muscular or intravenous route;
(e) Administer medications or supervise the
self-administration of medication route for which the MAP has not been
validated, with the exception of a rectal gel prescribed for seizures and
administered in an emergency situation;
(f) Administer medications or supervise the
self-administration of medication via a parenteral, subcutaneous, intra-dermal,
intra-muscular or intravenous route, with the exception of an epi-pen
administered in an emergency situation. This prohibition includes the
administration of insulin. However, a MAP may test blood sugar if the test is
not associated with insulin administration;
(g) Administer or supervise
self-administration of medications that are inserted vaginally, or administered
via a tracheostomy;
(h) Perform
irrigation of partial or full thickness wounds (such as vascular ulcers,
diabetic ulcers, pressure ulcers, surgical wounds) or apply agents used in the
debridement of necrotic tissues in wounds of any type;
(i) Supervise, monitor, prompt, assist or cue
a client to correctly fill a pill organizer (also known as a "pill minder" and
"pill box"); and
(j) Assist a
client with medications for which the health care provider's prescription or
order does not specify the medication schedule, medication amount, dosage,
route of administration, purpose for the medication, or with medication that
would require professional medical judgment by the MAP.
(k) Administer medications or supervise the
self-administration of medications from a pill organizer.
(8) A MAP who has been validated to
administer or supervise self-administration of prescribed enteral formulas
shall not:
(a) Administer prescribed enteral
formulas through a Gastrojejunal ("GJ") tube or any tube that requires venting
or suction;
(b) Administer
prescribed enteral formulas utilizing any procedures that require clinical
judgement, which is the process by which a licensed health care professional
decides on data to be collected about a client, makes an interpretation of the
data, arrives at a diagnosis, and identifies appropriate medical intervention;
this involves problem solving, decision making, and critical
thinking;
(c) Attempt to unclog an
obstructed tube;
(d) Replace or
attempt to replace a dislodged tube;
(e) Administer prescribed enteral formulas
through nasal tubes of any type. These are commonly known as, but not limited,
to nasogastric ("NG"), nasoduodenal ("ND"), and nasojejunal ("NJ")
tubes.
(9) MAPs shall
comply with section 393.506, F.S., and this
chapter.
(10) MAPs shall not:
(a) Obtain or attempt to obtain a passing
grade on either the training course exam or validation through fraud, deceit,
false statements, or misrepresentation of material facts, whether such
statements are made knowingly or negligently;
(b) Falsify any records regarding medication
administration;
(c) Continue to
provide services as a MAP if he or she fails to successfully pass required
re-validation on his or her primary route(s);
(d) Continue to provide medication
administration or supervision of medication administration via any of the
non-primary routes if he or she fails to successfully maintain his or her
validation for the non-primary route.
(d) Provide services as a MAP while not
currently authorized to do so by the State of Florida;
(e) Provide services as a MAP after the
Agency has determined the MAP shall not continue to provide medication
administration assistance.
(11) If a MAP violates any provision of
section 393.506, F.S., or this chapter,
the Agency shall:
(a) Prohibit the MAP from
providing medication administration services to clients of the
Agency;
(b) Request the MAP:
1. Successfully complete the Basic Medication
Administration Course and corresponding validation;
2. Successfully complete the Prescribed
Enteral Formula Administration Course and corresponding validation;
3. Participate in and successfully complete a
corrective action plan; and
4.
Comply with remediation requests.
(12) If a MAP or licensed health care
practitioner violates any provision of section
393.506, F.S., or this chapter
within an Agency-licensed residential facility, the Agency shall take such
actions as set forth in chapter 65G-2, F.A.C. against the residential facility
where the MAP or licensed health care practitioner is providing services as is
necessary to ensure the health, safety, and welfare of the Agency's clients and
third parties.
(13) Any person,
including licensed health care practitioners, who in good faith renders
emergency care or treatment in violation of this chapter, either in direct
response to emergency situations related to and arising out of a public health
emergency declared pursuant to section
381.00315, F.S., a state of
emergency which has been declared pursuant to section
252.36, F.S., or at the scene of
an emergency outside of a hospital, doctor's office, or other place having
proper medical equipment, without objection of the injured victim or victims,
shall not be held responsible for the administrative violation as a result of
such care or treatment where the person acts as an ordinary reasonably prudent
person would have acted under the same or similar
circumstances.
Rulemaking Authority
393.501,
393.506 FS. Law Implemented
393.506
FS.
New 3-30-08, Amended
7-1-19.
